Novel respiratory viruses in the context of mass-gathering events: A systematic review to inform event planning from a health perspective

ABSTRACT 

Background: Mass-gathering events (MGEs) occur regularly throughout the world. As people congregate at MGEs, there is an increased risk of transmission of communicable diseases. Novel respiratory viruses, such as Severe Acute Respiratory Syndrome Coronavirus-1 (SARS-CoV-1), Influenza A Virus Subtype H1N1 Strain 2009 (H1N1pdm09), Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), or Coronavirus Disease 2019 (COVID-19), may require specific infection prevention and control strategies to minimize the risk of transmission when planning MGEs. This literature review aimed to identify and analyze papers relating to novel respiratory viruses with pandemic potential and to inform MGE planning.

Method: This paper used a systematic literature review method. Various health care databases were searched using keywords relating to MGEs and novel respiratory viruses. Information was extracted from identified papers into various tables for analysis. The analysis identified infection prevention and control strategies used at MGEs to inform planning before, during, and following events.

Results: In total, 27 papers met the criteria for inclusion. No papers were identified regarding SARS-CoV-1, while the remainder reported on H1N1pdm09 (n = 9), MERS-CoV (n = 15), and SARS-CoV-2 (n = 3). Various before, during, and after event mitigation strategies were identified that can be implemented for future events.

Conclusions: This literature review provided an overview of the novel respiratory virus epidemiology at MGEs alongside related public health mitigation strategies that have been implemented at these events. This paper also discusses the health security of event participants and host communities in the context of cancelling, postponing, and modifying events due to a novel respiratory virus. In particular, ways to recommence events incorporating various mitigation strategies are outlined.

The full-text article is available here (PDF)

Ranse J, Beckwith D, Khan A, Yezli S, Hertelendy A, Hutton A, Zimmerman PA. (2021). Novel respiratory viruses in the context of mass gathering events: A systematic review to inform event planning from a health perspective. Prehospital and Disaster Medicine. [in-press]

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Novel respiratory viruses in the context of mass gathering events: A systematic review to inform event planning from a health perspective

I was invited to speak at the Qatar Health 2021 conference on the topic of mass gathering events. This presentation focused on a review of the literature regarding novel respiratory viruses in the context of mass gathering events. This presentation synthesised the literature relating to SARS-CoV-1, H1N1pdm09, and SARS-CoV-2 (COVID-19) in the context of mass gathering events.  Previously published infection prevention and control strategies were presented against a framework of pre, during, and after mass gathering event considerations. These infection preventions and control strategies o have implications for both event organisers and health officials when recommencing events in the context of COVID-19.

Ranse J. (2021). Novel respiratory viruses in the context of mass gathering events: A systematic review to inform event planning from a health perspective; invited speaker for Qatar Health 2021, Doha, Qatar, 21st January. [online]

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Environmental influences on patient presentations: Considerations for research and evaluation at mass-gathering events

Free full-text article is available here (PDF)

ABSTRACT

Aim: This paper discusses the need for consistency in mass-gathering research and evaluation from an environmental reporting perspective.

Background: Mass gatherings occur frequently throughout the world. Having an understanding of the complexities of mass gatherings is important to inform health services about the possible required health resources. Factors within the environmental, psychosocial, and biomedical domains influence the usage of health services at mass gatherings. A minimum data set (MDS) has been proposed to standardize collection of biomedical data across various mass gatherings, and there is a need for an environmental component. The environmental domain includes factors such as the nature of the event, availability of drugs or alcohol, venue characteristics, and meteorological factors.

Method: This research used an integrative literature review design. Manuscripts were collected using keyword searches from databases and journal content pages from 2003 through 2018. Data were analyzed and categorized using the existing MDS as a framework.

Results: In total, 39 manuscripts were identified that met the inclusion criteria. Conclusion: In collecting environmental data from mass gatherings, there must be an agreed-upon MDS. A set of variables can be used to collect de-identified environmental variables for the purpose of making comparisons across societies for mass-gathering events (MGEs).



Hutton A, Ranse J, Grey K, Turris S, Lund A, Munn BM. (2019). Environmental influences on patient presentations: Considerations for research and evaluation at mass-gathering events. Prehospital and Disaster Medicine.

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Enhancing the minimum data set for mass-gathering research and evaluation: An integrative literature review

Free full-text article is available here (PDF)

ABSTRACT:
Introduction: In 2012, a minimum data set (MDS) was proposed to enable the standardized collection of biomedical data across various mass gatherings. However, the existing 2012 MDS could be enhanced to allow for its uptake and usability in the international context. The 2012 MDS is arguably Australian-centric and not substantially informed by the literature. As such, an MDS with contributions from the literature and application in the international settings is required.

Methods: This research used an integrative literature review design. Manuscripts were collected using keyword searches from databases and journal content pages from 2003 through 2013. Data were analyzed and categorized using the existing 2012 MDS as a framework.

Results: In total, 19 manuscripts were identified that met the inclusion criteria. Variation in the patient presentation types was described in the literature from the mass-gathering papers reviewed. Patient presentation types identified in the literature review were compared to the 2012 MDS. As a result, 16 high-level patient presentation types were identified that were not included in the 2012 MDS.

Conclusion: Adding patient presentation types to the 2012 MDS ensures that the collection of biomedical data for mass-gathering health research and evaluation remains contemporary and comprehensive. This review proposes the addition of 16 high-level patient presentation categories to the 2012 MDS in the following broad areas: gastrointestinal, obstetrics and gynecology, minor illness, mental health, and patient outcomes. Additionally, a section for self-treatment has been added, which was previously not included in the 2012 MDS, but was widely reported in the literature.


Ranse J, Hutton A, Turris S, Lund A. (2014). Enhancing the minimum data set for mass gathering research and evaluation: An integrative literature review. Prehospital Disaster Medicine. 29(3):1-10.

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Progressing towards an international consensus on data modelling for mass gathering and mass participation events

This presentation was undertaken by Adam Lund for this research team.

ABSTRACT
There is call for increased attention to foundational theory building to support the evidence base for mass gathering medicine/health (MGM/H). There is a need for a more consistent approach to data collection, case reporting, and research methodology. Recently publications highlight the need for agreement on data points across varying MGM/H contexts.

This discussion aims to present a supportive rather than prescriptive process of building consensus that will support MGM/H researchers and clinicians to produce work with value to international events. The authors propose an ongoing, iterative, collaborative process with the goal of developing and maintaining consensus on core concepts, methodology, and reporting in MGM/H research and evaluation. Stakeholder input will be sought internationally from researchers, advocacy groups, and operational personnel who may undertake literature reviews, research collaboration, consensus meetings, as well as iterative document creation and review.

The authors propose five conceptual categories as a starting point for analysis and discussion: 1) Event & Community (prospective & retrospective) - describing events so events in different parts of the world can be compared reliably; 2) Health Team Resources - describing personnel, equipment, assets, policies, protocols and other factors that impact on-site care; 3) Patient - describing patient encounters, history, findings, treatment, response, and outcome; supporting a minimum common set of descriptors of patient factors; 4) Reporting - standardized descriptive, summative, or analytic reporting “fields” and formats that would permit a more consistent understanding of events and increase the ability to perform meta-analyses of events; and, 5) Overview of Research Methodologies – review and categorization of common methodologies in the MGM/H literature, including summarization of best practices to support future inquiry into MGM/H.

This proposed method of consensus will allow mass gathering health science to become more robust and be generalizable to other MGM/H events.



Lund A, Turris S, Bowles R, Gutman S, Hutton A, Ranse J, Arbon P. (2013). Progressing towards an international consensus on data modelling for mass gathering and mass participation events; paper presented at the 18th World Congress on Disaster and Emergency Medicine, Manchester, UK, May.

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Biomedical data collection for mass gathering research and evaluation: A review of the literature

ABSTRACT
Internationally, planned events such as mass gatherings occur frequently. Known factors influencing the usage of health services, or patient presentations, at mass-gatherings are acknowledged within the environmental, psychosocial and biomedical domains. Health-related research and evaluation from mass gatherings commonly include biomedical information pertaining to patient presentations. The aim of this research was to review the various categorisations reported by authors to describe the patient populations at mass-gatherings, with a focus only on the biomedical domain.

This research utilised an integrative literature review methodology to identify papers from within the last ten years that included research or evaluation from a mass-gathering event in which the authors included published biomedical information.

Numerous papers were identified that included information pertaining to biomedical information from mass gathering events. It was noted that the coding and categorisation of patient-level biomedical information seems inconsistent, varied, haphazard and author dependent.

Recently, there has been literary discussion about the need for consistency and consensus in reporting on biomedical information. This literature review supports this notion. In particular, this presentation builds on a previously published minimum data set proposed by Ranse and Hutton and enhances it by including additional categorisations of biomedical information. As such, a revised minimum data set with a data dictionary is proposed in an effort to generate conversation about a possible agreed minimum amount and the type of information that should be collected consistently for research and evaluation at mass gatherings.


Ranse J, Hutton A. (2013). Biomedical data collection for mass gathering research and evaluation: A review of the literature; paper presented at the 18th World Congress on Disaster and Emergency Medicine, Manchester, UK, May.

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Minimum data set for mass-gatherings health research and evaluation: The beginning of an international dialogue

I was fortunate to have someone write a letter to the editor to my original article titled: Minimum data set for mass-gatherings health research and evaluation, which was coauthored with Dr Allison Hutton. This letter to the editor was published in the journal Prehospital and Disaster Medicine. The authors make a number of suggestions to enhance our proposed minimum data set. Additionally, the authors invite us to meet and collaborate with them on future research activities.

In response to this letter to the editor, Allison Hutton and I wrote a response. This response was also published in Prehospital and Disaster Medicine.

Essentially, this response reiterated our original discussion paper regarding the need for some consistency internationally in the reporting of research and evaluations from mass gatherings. In particular, our original work focused on the need to move from author-dependent, author-varied and author-self-generated data sets to an internationally agreed set of minimum variables for collection at mass gatherings. The aim of this would be to compare events internationally, to gain a better understanding of health service requirements during a mass gathering. Additionally, we have accepted the invitation to meet with the authors who wrote the letter to the editor, and will meet with them face-to-face in May 2013 in Manchester, United Kingdom.


Ranse J, Hutton A. (2013). Minimum data set for mass-gatherings health research and evaluation: The beginning of an international dialogue. Prehospital and Disaster Medicine. [author reply]. 28(2):3

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Minimum data set for mass gathering health research and evaluation: A discussion paper

This paper aims to commence international discussions regarding the need to have a standardised approach to the reporting of biomedical information from mass gatherings. In particular it focuses on the need to have consistency in the reporting of patient presentation rates, medical usage rates, referral to hospital rates and transport to hospital rates. Additionally, it highlights the need for the consistent use of a research and evaluation tool, such as a minimum data set. This paper provides an example of a minimum data set, as an opportunity to commence these international discussions.


ABSTRACT
This paper discusses the need for consistency in mass gathering data collection and biomedical reporting. Mass gatherings occur frequently throughout the world and having an understanding of the complexities of mass gatherings is important to inform health services about the possible required health resources. Factors within the environmental, psychosocial and biomedical domains influence the usage of health services at mass gatherings. The biomedical domain includes the categorisation of presenting injury or illness and rates such as patient presentation rate, transferred to hospital rate and referred to hospital rate. These rates provide insight into the usage of onsite health services, prehospital ambulance services and hospital emergency department services.

Within the literature these rates are reported in a manner that is varied, haphazard and author dependent. This paper proposes moving from an author dependent practice of collection and reporting of data. An expert consensus approach is proposed as a means of further developing mass gathering theory and moving beyond the current situation of reporting on individual case studies. To achieve this minimum data set with a data dictionary is proposed in an effort to generate conversation about a possible agreed minimum amount and type of information that should be consistently collected for research and evaluation at mass gatherings. Finally, this paper outlines future opportunities that will emerge from the consistent collection and reporting of mass gathering data, including the possibility for meta-analysis, comparison of events across societies and modelling of various rates to inform various health services.


Ranse J, Hutton A. (2012). Minimum data set for mass gathering health research and evaluation: A discussion paper. Prehospital and Disaster Medicine. 27(6):1-8. doi:10.1017/S1049023X12001288

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